Addressing Suspicions of Malingering

   Many times situations arise in cases that create a suspicion of symptom magnification or malingering.  When this issue is present, there are concerns that the claimant may be exaggerating pain behaviors for financial incentive or to avoid returning to work.  Some of the identified risk factors for malingering include ongoing litigation, significant discrepancy between subjective disability and objective findings, and lack of cooperation with the evaluation and with treatment.  Unfortunately, confirmation of malingering is difficult for physicians.

      A number of tests are utilized to assist physicians with determining whether there is a legitimate physical cause for a patient’s pain behavior.  One test physicians use to assess a patient’s pain behavior when there are complaints of back pain was created by Dr. Gordon Waddell.  Dr. Waddell placed eight signs into five categories to identify patients that may require a more detailed assessment due to concerns of symptom exaggeration.  The test is often referred to as the Waddell’s sign or Waddell’s test. Examples of positive Waddell’s signs for the five categories include the following:

1.   Tenderness:  Deep tenderness over a wide area or light pinching causing pain is a positive sign.  Generally, physical back pain does not make the skin tender to light touch.

2.  Stimulation:  Downward pressure on the head that results in lower back pain or rotation of the shoulders and pelvis in unison resulting in pain is a positive sign.

3.  Distraction:  Straightening the leg with the hip flexed 90 degrees that results in pain is a positive sign.

4. Regional:  Weakness in multiple muscles not enervated by the same root sensation is a positive sign.

5. Overreaction:  An excessive show of emotion (i.e. a disproportionate grimace, tremor, bracing, guarding or exaggerated verbalizations) is a positive sign.

      Ultimately, the presence of three or more Waddell’s signs is considered a positive finding and suggests that the patient may not have a straightforward medical problem. Isolated positive signs are typically ignored.  During the years since Dr. Waddell’s paper was published in 1980, the Waddell’s signs have received extreme criticism and there have been allegations of misinterpretation and misuse of Waddell’s signs clinically and medical-legally.  Therefore, to strengthen the opinion of examining physicians when it comes to a finding of malingering, it is always beneficial to have additional evidence (i.e. witness testimony, surveillance, etc.) to show contradictory events and support that the claimant is exaggerating his/her pain level.

By: Kawania James, Esq.